Benefits of Hypertension Treatment Depends Somewhat on Starting Blood Pressure Level

MedicalResearch.com Interview with:

Blood pressure monitor reading 120/80 copyright American Heart Association

Blood pressure monitor reading 120/80
copyright American Heart Association

Dr. Mattias Brunström
Department of Public Health and Clinical Medicine
Umeå University,Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current guidelines recommend a systolic blood pressure treatment target below 140 mm Hg for most people. Since the publication of SPRINT however, many have suggested guidelines should be changed, recommending further blood pressure lowering.

We performed a systematic review and meta-analysis of randomized clinical trials comparing different blood pressure targets or antihypertensive treatment verus placebo. We separated primary preventive trials from secondary preventive trials, and stratified primary preventive trials by mean baseline systolic blood pressure. The analyses included 74 trials, with in total > 300 000 participants. Interestingly, we found that treatment effect was dependent on baseline systolic blood pressure in people without previous CVD.

While primary preventive treatment reduced the risk of death and cardiovascular disease if systolic blood pressure was 140 mm Hg or higher, treatment effect was neutral if systolic blood pressure was below 140 mm Hg.

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SPRINT Trial: Greater Mean Blood Pressure Reductions Linked To Increased Risk of Kidney Function Decline

MedicalResearch.com Interview with:
Rita Magriço MD

Hospital Garcia de Orta
Almada, Portugal 
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The SPRINT trial showed that in non-diabetic patients with high cardiovascular risk, intensive systolic blood pressure treatment (<120 mmHg) was associated with lower rates of major cardiovascular events and mortality. However, intensive treatment was unexpectedly associated with increased kidney function decline.

We thought that lowering blood pressure could compromise kidney perfusion, evaluated by mean arterial pressure (MAP). If so, the magnitude of MAP reduction was expected to be associated with kidney function decline. We hypothesized that a greater difference between the baseline MAP and the lowest achieved MAP may be associated with a higher risk of kidney function decline.

Our analysis supports this hypothesis. We discovered that MAP reduction >20 mmHg in patients with a target systolic BP <120 mmHg was associated with higher incidence of kidney function decline. The benefit-risk balance of intensive treatment seemed to be less favourable with greater MAP reduction. Prospective studies evaluating the effect of MAP reduction in addition to hypertension treatment target on kidney function decline and cardiovascular events are warranted.

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Maternal Blood Pressure Rise During Pregnancy Linked To Increased Risk Of Childhood Obesity

MedicalResearch.com Interview with:

Duo Li, PhD Chief professor of Nutrition Institute of Nutrition and Health Qingdao University, China. 

Dr. Duo Li

Duo Li, PhD
Chief professor of Nutrition
Institute of Nutrition and Health
Qingdao University, China. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Childhood obesity is becoming an emerging public health issue worldwide, owing to its association with a variety of health problems at younger ages in adulthood, including obesity, type 2 diabetes and cardiovascular diseases. Identification of prenatal and early life risk factors is key for curbing the epidemic of the childhood obesity.

Main finding of the present study is that among pregnant women, elevated blood pressure is associated with a greater risk of overweight and obesity for their children.

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Targeting a Lower Systolic Blood Pressure Likely To Be Well Tolerated, Even In Elderly

MedicalResearch.com Interview with:
Dan Berlowitz, MD, MPH

Investigator, CHOIR
Chief of Staff, Edith Nourse Rogers Memorial VA Hospital
Professor, Boston University Schools of Public Health and Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main results from the SPRINT study, published in 2015, demonstrated that intensive hypertension therapy targeting a systolic blood pressure (SBP) of 120 mm Hg results in reduced cardiovascular morbidity and mortality when compared to standard therapy targeting a SBP of 140. Yet many have expressed concerns that lowering SBP to 120 may be associated with a variety of symptoms, including dizziness, fatigue, and depression, especially in older and frailer patients.

This study using SPRINT data examined patient-reported outcomes including health-related quality of life, depressive symptoms, and satisfaction.

The main findings are that there were no differences in patient-reported outcomes among patients receiving intensive therapy compared to standard therapy, even among older SPRINT participants with multiple comorbidities.

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CALM Study Launches Trial of MobiusHD Carotid Implant For Resistant Hypertension

MedicalResearch.com Interview with:

Gregg W. Stone MD Professor of Medicine Columbia University Director of Cardiovascular Research and Education Center for Interventional Vascular Therapy New York Presbyterian Hospital/ Columbia University Medical Center Co-Director of Medical Research and Education The Cardiovascular Research Foundation New York, NY

Dr. Stone

Gregg W. Stone MD
Professor of Medicine
Columbia University
Director of Cardiovascular Research and Education
Center for Interventional Vascular Therapy
New York Presbyterian Hospital/ Columbia University Medical Center
Co-Director of Medical Research and Education
The Cardiovascular Research Foundation
New York, NY


MedicalResearch.com:
How does the MobiusHD system work?

Response: The MobiusHD System is a thin stent-like device which is implanted during a minimally invasive procedure into the carotid artery. The MobiusHD modifies the activity of baroreceptors located in the carotid artery, increasing arterial vasodilation to reduce blood pressure.

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Study Suggests Isolated Systolic Hypertension In Young Adults Should Be Treated To Prevent Damage To Aorta

MedicalResearch.com Interview with:

Wanpen Vongpatanasin, M.D.</strong> Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586

Dr. Vongpatanasin

Wanpen Vongpatanasin, M.D.
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension
Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research
Director, Hypertension Section,
Cardiology Division,
UT Southwestern Medical Center
Dallas, TX 75390-8586

MedicalResearch.com: What is the background for this study?

Response: It is well know that treatment of isolated systolic hypertension (ISH), a subtype of hypertension with elevated systolic BP 140 or above but normal diastolic BP of < 90 mmHg, improves cardiovascular outcomes in older adults after the sixth decade of life. However, it is controversial if ISH in young adults requires treatment because it was suggested that elevated systolic BP in these individuals are related to high stroke volume, rather than increased aortic stiffness. In earlier case series, ISH in young adults were particularly common in athletes with long arms and legs, suggesting that pulse wave amplification coupled with high stroke volume were responsible for elevated brachial systolic blood pressure but the true central BP was normal. Thus,  isolated systolic hypertension was proposed to be a spurious condition in young adults that can be ignored.

However, previous studies used only indirect technique in assessing aortic structure and function. Furthermore, none of these studies were conducted in the U.S. Population.

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SPRINT Trial: Intensive Blood Pressure Control Reduces Risk of LVH

MedicalResearch.com Interview with:

Elsayed Z. Soliman MD, MSc, MS, FAHA, FACC Director, Epidemiological Cardiology Research Center (EPICARE) Professor, Department of Epidemiology and Prevention Professor, Department of Internal Medicine, Cardiology Section Wake Forest School of Medicine Medical Center Blvd, Winston Salem, NC 27157

Dr. Soliman

Elsayed Z. Soliman MD, MSc, MS, FAHA, FACC
Director, Epidemiological Cardiology Research Center (EPICARE)
Professor, Department of Epidemiology and Prevention
Professor, Department of Internal Medicine, Cardiology Section
Wake Forest School of Medicine
Medical Center Blvd, Winston Salem, NC 27157

MedicalResearch.com: What is the background for this study?

Response: We already know that left ventricular hypertrophy (LVH, which is the most common complication of high blood pressure, is associated with an increased risk of cardiovascular disease (CVD). We also know that successful management of high blood pressure (BP) leads to regression of LVH and improved CVD outcomes in patients with hypertension. However, it is unknown whether intensive BP lowering beyond that recommended would reduce the risk of LVH in patients with hypertension, and whether reducing the risk of LVH explains the reported CVD benefits of intensive BP lowering in this population. Therefore, we examined the differential impact of intensive BP lowering (target systolic BP (SBP).

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Chronic Kidney Disease Still Highly Prevalent in Hypertensive Patients

MedicalResearch.com Interview with:
Tanushree Banerjee, M.S., M.Phil., Ph.D.
Research Specialist,
Department of General Internal Medicine,
San Francisco General Hospital,
University of California, San Francisco,

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prevalence of chronic kidney disease (CKD) has increased among adults with diagnosed hypertension (HTN), undiagnosed HTN and pre-hypertension as compared to normotension. However, whether CKD prevalence has changed across each of these groups is unknown.

The prevalence of CKD decreased over time among persons with diagnosed, undiagnosed, and pre-hypertension while there was not any change in normotensives.

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Rotational Shift Work Linked To Increased Risk of Hypertension, Especially in Men

MedicalResearch.com Interview with:

Sandhya Manohar, MBBS, Nephrology Fellow Project mentor: Sandra M. Herrmann, MD Department of Nephrology and Hypertension Mayo Clinic, Rochester, MN

Dr. Sandhya Manohar

Sandhya Manohar, MBBS, Nephrology Fellow
Project mentor: Sandra M. Herrmann, MD
Department of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

MedicalResearch.com: What is the background for this study?

Response: In the last few decades advances in the field of industrialization and technology has turned our world into a 24-7 work zone. Many organizations have turned to a shift system to keep up with the demands of the new world. The consequent changes to our circadian rhythm have resulted in dramatic effects to our body’s physiology. Reports have been surfacing of higher rates of diabetes, obesity, and even cancer in this shift work population.

The risk of hypertension though was controversial and so we set out to review this in our meta-analysis.

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Pregnant Women Should Have Blood Pressure Screening for Preeclampsia Throughout Pregnancy

MedicalResearch.com Interview with:

Dr. Maureen Phipps, USPTS Task Force member Department chair and Chace-Joukowsky professor of obstetrics and gynecology Assistant dean for teaching and research on women's health Warren Alpert Medical School of Brown University

Dr. Phipps

Dr. Maureen Phipps, USPTS Task Force member
Department chair and Chace-Joukowsky professor of obstetrics and gynecology
Assistant dean for teaching and research on women’s health
Warren Alpert Medical School of Brown University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Preeclampsia, which includes high blood pressure after 20 weeks of pregnancy, is one of the most serious health problems affecting pregnant women. After reviewing the evidence, the Task Force found the benefits of screening for preeclampsia outweighed the harms and recommended screening pregnant women for preeclampsia with blood pressure measurements throughout pregnancy. The evidence showed mothers and their babies are likely to benefit from screening, as screening leads to treatment that reduces their risk of severe complications, including death.

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Men and African Americans More Likely To Transition to Hypertension At Younger Age

MedicalResearch.com Interview with:

Shakia Hardy, MPH, CPH. PhD

Dr. Hardy

Shakia Hardy, MPH, CPH. PhD
Department of Epidemiology
The University of North Carolina at Chapel Hill

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies characterizing blood pressure levels across the life course have relied on prevalence estimates at a given age.

Our study was interested in identifying critical ages at which net transitions between levels of blood pressure occurred. We used data from the National Health and Nutrition Examination Survey (2007-2012) to estimate age-, race-, and sex-specific annual net transition probabilities between ideal blood pressure, prehypertension and hypertension.

We found that African Americans and men were more likely to transition from ideal levels of blood pressure in childhood or early adulthood compared to white Americans and women, which puts them at increased risk of developing prehypertension and hypertension earlier in life.

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Intensive Systolic Blood Pressure Control Would Risk Side Effects But Save Lives

MedicalResearch.com Interview with:

Dr. Adam Bress, PharmD, MS. Assistant Professor, Population Health Sciences Division of Health System Innovation and Research University of Utah

Dr. Adam Bress

Dr. Adam Bress, PharmD, MS.
Assistant Professor, Population Health Sciences
Division of Health System Innovation and Research
University of Utah

MedicalResearch.com: What is the background for this study?

  • Observational studies show a strong and graded association between higher blood pressure, beginning at 115 mm Hg systolic, and increased cardiovascular disease events.
  • Despite this, hypertension is diagnosed and treated among people with a blood pressure threshold, typically 140/90 mm Hg SBP/DBP.
  •  Until recently, randomized trials did not provide definitive evidence supporting lower SBP goals in high-risk sub-populations.
  • The Systolic Blood Pressure Intervention Trial showed that among U.S. adults at high cardiovascular disease risk but without diabetes, stroke, or heart failure, treating to a systolic blood pressure goal of 120 mm Hg compared to the standard goal of 120 mm Hg compared to the standard goal of <140 mm Hg, resulted in a 27 % reduction in all-cause mortality.
  • However, intensive treatment cause a higher rate of treatment-related serious adverse events (SAEs).

MedicalResearch.com: What are the main findings?

  • To quantify the potential benefits and risks of SPRINT intensive goal implementation, we estimated the deaths prevented and excess SAEs incurred if the SPRINT intensive SBP goal (i.e., – Based on population estimates of U.S adults that would have been eligible for the SPRINT trial and their observed 5-year mortality rate and the treatment effects observed in SPRINT, we found that if intensive treatment is widely adopted and achieved in all of these people, about 100,000 deaths per year could be prevented.
  • It could also give rise to about 56,100 episodes of hypotension, 34,400 episodes of syncope, 43,400 serious electrolyte disorders, and 88,700 cases of acute kidney injury per year compared to standard blood pressure treatment.

MedicalResearch.com: What should readers take away from your report?

  • The public health impact of wide-spread implementation of intensive blood pressure treatment in the right patients is large.
  • However, careful patient selection and implementation are important because intensive treatment is associated with increased risk of hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

  • More research is needed to determine which patients derive the largest absolute benefit from intensive blood pressure treatment in order to maximize health benefits and minimize harms.
  • Research and development of tools to enhance shared decision making between providers and patients is also needed to maximize the positive public health impact of intensive blood pressure treatment.

MedicalResearch.com: Is there anything else you would like to add?

Response: I am a member of the SPRINT Research Group

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Circulation. 2017 Feb 13. pii: CIRCULATIONAHA.116.025322. doi: 10.1161/CIRCULATIONAHA.116.025322. [Epub ahead of print]
Potential Deaths Averted and Serious Adverse Events Incurred from Adoption of the SPRINT Intensive Blood Pressure Regimen in the U.S.: Projections from NHANES.
Bress AP1, Kramer H2, Khatib R3, Beddhu S4, Cheung AK4, Hess R5, Bansal VK6, Cao G3, Yee J7, Moran AE8, Durazo-Arvizu RA3, Muntner P9, Cooper RS3

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Over 100 Genetic Signals Influence Blood Pressure

MedicalResearch.com Interview with:

Helen R Warren PhD</strong> Analysis, Statistics, Genetic Epidemiology Queen Mary, University of London

Dr. Helen Warren

Helen R Warren PhD
Analysis, Statistics, Genetic Epidemiology
Queen Mary, University of London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study analysed data from UK Biobank, which is a large cohort including over 500,000 male and female participants from across the UK, aged 40-69 years. We performed a genetic association study for blood pressure, which analysed ~140,000 individuals of European ancestry (as currently interim genetic data is only available for ~150,000 participants).

Our study identified 107 genetic regions associated with blood pressure, which had not been previously reported at the time of our analysis. All our new findings were robustly validated within independent replication data resources, comprising a large, total sample size of up to 420,000 individuals.

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Hypertension in Pregnancy Linked To Early Mortality

MedicalResearch.com Interview with:
Dr. Lauren Theilen, MD

Obstetrics/Gynecology specialist
Salt Lake City, Utah.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Women with a history of hypertensive disease of pregnancy are known to have increased risk of mortality from cardiovascular and other causes.

Our study shows that hypertensive disease of pregnancy is strongly associated with deaths due to diabetes, heart disease, and stroke. The association is strongest for early mortality – deaths occurring before age 50 – and life expectancy decreases with increasing number of affected pregnancies.

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Hypertension Is Global Risk For Disability and Premature Death

MedicalResearch.com Interview with:

Dr. Gregory Roth MD Assistant Professor of Medicine Institute for Health Metrics and Evaluation and Division of Cardiology at the University of Washington

Dr. Gregory Roth

Dr. Gregory Roth MD
Assistant Professor of Medicine
Institute for Health Metrics and Evaluation and
Division of Cardiology at the University of Washington

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The number of people in the world with high blood pressure has doubled in the past two decades, putting billions at an increased risk for heart disease, stroke, and kidney disease. In the current study, we aimed to estimate the association between systolic blood pressure (SBP) over 115 mm Hg, as well as SBP over 140 mm Hg, a condition known as hypertension, and the burden of different causes of death and health burden for 195 countries and territories over time.

In 2015, an estimated 3.5 billion adults had systolic blood pressure of at least 110 to 115 mm Hg, and 874 million adults had SBP of 140 mm Hg or higher. In addition, the rate of elevated SBP increased substantially between 1990 and 2015, and disability-adjusted life-years (DALYs) and deaths associated with elevated systolic blood pressure also increased.

Countries of lower developmental status – measured by the Socio-demographic Index (SDI) – saw greater increases in the number of deaths linked to elevated SBP than the most developed countries. The largest percent increase in elevated systolic blood pressure deaths between 1990 and 2015 occurred in low-middle countries (107%), and the most deaths occurred in high-middle SDI counties (2,844,499 deaths).

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Compared To Other Blood Pressure Medications Diuretics Have Bone Protective Effect

MedicalResearch.com Interview with:

Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096

Dr. Joshua I. Barzilay

Joshua I. Barzilay, MD
Kaiser Permanente of Georgia
Duluth, GA 30096

MedicalResearch.com: What is the background for this study?

Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis.

Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified.

After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion.

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Increased Aortic Stiffness May Explain Elevated Hypertension Risk in African Americans

MedicalResearch.com Interview with:

Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586

Dr. Wanpen Vongpatanasin

Wanpen Vongpatanasin, M.D.
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension
Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research
Director, Hypertension Section,
Cardiology Division,
UT Southwestern Medical Center
Dallas, TX 75390-8586

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Aortic stiffness is known to be associated with cardiovascular disease, including heart attack, stroke, and heart failure, possibly related to increase afterload to the left ventricle. Previous studies have not directly assessed proximal aortic function among ethnic minorities in the United States. We evaluated the multiethnic, population-based Dallas Heart Study participants (N=2544, 54.2% women, 49.7% Black) who underwent cardiovascular magnetic resonance imaging (CMR) at 1.5 Tesla. Aortic stiffness and characteristic impedance (Zc) were determined from aortic arch PWV and lumen area measurements. Linear regression was used to evaluate ethnic differences in proximal aortic wall stiffness using aortic arch PWV and Zc as dependent variables with and without adjustment for traditional cardiovascular risk factors.

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Lower Salt Intake Linked To Decreased Blood Pressure, Heart Disease and Mortality

MedicalResearch.com Interview with:

Nancy Cook ScD Professor of Medicine, Harvard Medical School Professor in the Department of Epidemiology Harvard T.H. Chan School Public Health Brigham & Women’s Hospital Division of Preventive Medicine Boston, MA 0221

Dr. Nancy Cook

Nancy Cook ScD
Professor of Medicine, Harvard Medical School
Professor in the Department of Epidemiology
Harvard T.H. Chan School Public Health
Brigham & Women’s Hospital Division of Preventive Medicine
Boston, MA 02215

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The association of sodium intake with later mortality has been controversial. While there is a well-accepted effect on blood pressure, the effects of sodium on later cardiovascular disease, and particularly mortality, have been subject to dispute. While the adverse effects of high sodium are now widely accepted, effects at lower levels of sodium intake are less clear. Some recent studies have found a J-shaped relationship, with increased disease rates among those consuming lower levels of sodium, contrary to the effects on blood pressure.

In contrast, we found a direct linear relationship of usual intake of sodium with later mortality over 20 years of follow-up. Those with the lowest sodium intake experienced the lowest mortality. Our measure of intake was based on the average over 1-3 years of several measures of 24hr urine sodium excretion, the gold standard of sodium measurement. This is much more precise than measurements based on a single 24hr sodium excretion or especially on a spot urine sample, which is used in many publications that found the J-shaped curve. Our data were assessed in a healthy cohort of men and women without hypertension or cardiovascular disease, so had less potential bias due to these factors. We thus believe that our results showing the lowest mortality among those consuming the lowest levels of sodium are more accurate.

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Large fluctuations in blood pressure associated with higher risk of heart disease and kidney failure

MedicalResearch.com Interview with:

Elvira Gosmanova MD Department of Nephrology University of Tennessee Health Science Center Memphis TN, 38163

Dr. Elvira Gosmanova

Elvira Gosmanova MD
Department of Nephrology
University of Tennessee Health Science Center
Memphis TN, 38163

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It has been long known that elevated blood pressure is a risk factor for numerous adverse health-related outcomes. However, the majority of individuals do not have blood pressure in a constant range.

In contrary, blood pressure measured in the same individual tends to fluctuate over time. Moreover, some individuals have more blood pressure fluctuation, as compared with others. The impact of fluctuation in blood pressure is still poorly understood. Smaller studies suggested that increased fluctuation in blood pressure may be associated with hazardous health outcomes. However, large scale studies were still lacking. Therefore, we conducted a study involving close to 3 million US veterans to investigate the association of increased visit-to-visit variability of systolic blood pressure (which was our measure of fluctuation of blood pressure over time) and all-cause mortality, and incident coronary heart disease, stroke, and end-stage renal disease.

We found that there was strong and graded increase in the risk of all the above outcomes with increasing visit-to-visit variability of systolic blood pressure.

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Intensive Blood Pressure Control of More Americans Could Further Reduce Annual Mortality Rate

MedicalResearch.com Interview with:

Holly Mattix-Kramer, MD, MPH</strong> Public Health Sciences Medicine, Nephrology Associate Professor Loyola Medicine, Illinois

Dr. Holly Mattix-Kramer

Holly Mattix-Kramer, MD, MPH
Public Health Sciences
Medicine, Nephrology
Associate Professor
Loyola Medicine, Illinois

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background is that the Systolic Blood Pressure Lowering Intervention Trial (SPRINT) showed that intensive systolic blood pressure lowering reduces all-cause mortality by 27% compared to standard blood pressure lowering among adults age 50 years and older without diabetes or stroke but with high cardiovascular disease risk. We applied these findings to the U.S. population and asked “What if intensive systolic blood pressure lowering were applied to the U.S. population who meet SPRINT eligibility criteria?

We found that approximately 18.1 million U.S. adults meet SPRINT criteria and that their annual mortality rate is 2.2%. If intensive systolic blood pressure lowering reduces all-cause mortality by 27%, then the annual mortality rate would be reduced to 1.6% and approximately 107,500 deaths would be prevented each year.

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Intensive Blood Pressure Management Found To Be Cost Effective

MedicalResearch.com Interview with:

Ilana B. Richman, MD Palo Alto VA Health Care System, Palo Alto, California Center for Primary Care and Outcomes Research/Center for Health Policy Department of Medicine Stanford University School of Medicine Stanford, California

Dr. Ilana B. Richman

Ilana B. Richman, MD
Palo Alto VA Health Care System, Palo Alto, California
Center for Primary Care and Outcomes Research/Center for Health Policy
Department of Medicine
Stanford University School of Medicine
Stanford, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In November of 2015, researchers published results from the Systolic Blood Pressure Intervention Trial (SPRINT). This large, NIH-funded study compared a systolic blood pressure target of 120 mm Hg vs 140 mm Hg among hypertensive, nondiabetic patients at elevated risk for cardiovascular disease. SPRINT reported a 25% reduction in the rate of cardiovascular disease and death among those treated to a lower target. Those treated to a lower target blood pressure, though, experienced certain adverse events more frequently.

Our cost effectiveness analysis asked two questions: given the potential risks and benefits described in SPRINT, does achieving a lower systolic blood pressure result in net benefit over the course of a lifetime? And if it does, how much would it cost, compared to standard treatment? We found that achieving a lower blood pressure target does result in a net benefit, with a gain of about 0.9 years of life (quality adjusted) among those treated to a lower target compared to those treated to a standard target. This gain, though, required some investment. We found that treating to a lower blood pressure target cost $23,777 per quality-adjusted life year gained. Compared to other commonly used interventions here in the US, this would be considered an excellent value.

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Controversy Over Salt Content Continues

Salt-SodiumMedicalResearch.com Interview with:
Prof Andrew Mente PhD
Clinical Epidemiology and Biostatistics, McMaster University
Hamilton, Canada

MedicalResearch.com Editor’s Note:  Dr. Mente discusses his Lancet publication regarding salt intake below.  Dr. Mente’s findings are disputed by the American Heart Association (AHA).  A statement from the AHA follows Dr. Mente’s comments.

MedicalResearch.com: What is the background for this study? What are the main findings?

Prof. Mente: Several prospective cohort studies have recently reported that both too little and too much sodium intake is associated with cardiovascular disease or mortality. Whether these associations vary between those individuals with and without high blood pressure (hypertension) is unknown.

We found that low sodium intake (below 3 g/day), compared to average intake (3 to 6 g/day), is associated with more cardiovascular events and mortality, both in those with high blood pressure and in those without high blood pressure. So following the guidelines would put you at increased risk, compared to consuming an sodium at the population average level, regardless of whether you have high blood pressure or normal blood pressure.

High sodium intake (above 6 g/day) compared to average intake, was associated with harm, but only in people with high blood pressure (no association in people without high blood pressure).

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Daytime Naps May Raise Your Blood Pressure

MedicalResearch.com Interview with:

Wisit Cheungpasitporn, MD, Nephrology Fellow Project mentor: Stephen B. Erickson, MD Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MN

Dr. Wisit Cheungpasitporn

Wisit Cheungpasitporn, MD, Nephrology Fellow
Project mentor: Stephen B. Erickson, MD
Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Cheungpasitporn: The prevention and management of hypertension continue to be major public health challenges. Studies have shown the benefits of napping, including reduction of fatigue and improvement of alertness, mood and work performance. However, there have also been increasing reported associations between napping and cardiovascular disease, diabetes mellitus, strokes, and higher mortality from all causes. The risk of hypertension in adults who regularly take a nap is controversial.

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Postpartum Screening Important For Women With Hypertension During Pregnancy

MEDICALRESEARCH.COM INTERVIEW WITH:
KRISTI REYNOLDS, PHD, MPH 

MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH KAISER PERMANENTE RESEARCH RESEARCH & EVALUATION PASADENA, CA 91101

Dr. Kristi Reynolds

KAISER PERMANENTE RESEARCH
RESEARCH & EVALUATION
PASADENA, CA 91101 

Medical Research: What is the background for this study?

Dr. Reynolds: Hypertensive disorders during pregnancy are common, affecting up to 10 percent of all pregnant women, and include gestational hypertension, preeclampsia (which is a combination of high blood pressure and protein in the urine), and eclampsia, which includes seizures in women with severe preeclampsia. Research has shown that hypertensive disorders in pregnancy are associated with long-term cardiovascular disease risk, but little is known about the effect of these conditions in the early years after delivery.

As part of our study, we examined the electronic health records of 5,960 women who had prenatal care and delivered a baby at the Kaiser Permanente Southern California Bellflower Medical Center between 2005 and 2010. Women with high blood pressure before their pregnancy were excluded from the analysis.

Medical Research: What are the main findings?

Dr. Reynolds: We found that women who had a hypertensive disorder during pregnancy were 2.4 times more likely – and women with pre-eclampsia/eclampsia 2.5 times more likely – to develop pre-hypertension or hypertension in the year after delivery than those who maintained a normal blood pressure during their pregnancy, after controlling for differences between the groups.

In comparison to women with normal blood pressure during pregnancy, women with pregnancy-related hypertension tended to be slightly younger and overweight or obese before pregnancy. In addition, they were more likely to have had one or more children previously and to gain excess weight and develop gestational diabetes during their pregnancy.

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Should All Patients with Resistant Hypertension Be Screened for Primary Aldosteronism?

Carrie C. Lubitz, MD, MPH Assistant Professor of Surgery, Harvard Medical School Senior Scientist, Institute for Technology Assessment Attending Surgeon, Mass General/North Shore Center for Outpatient Care Danvers, Massachusetts

Dr. Lubitz

MedicalResearch.com Interview with:
Carrie C. Lubitz, MD, MPH
Assistant Professor of Surgery, Harvard Medical School
Senior Scientist, Institute for Technology Assessment
Attending Surgeon, Mass General/North Shore Center for Outpatient Care
Danvers, Massachusetts

Medical Research: What is the background for this study? What are the main findings?

Dr. Lubitz: Given reported estimates of resistant hypertension and the proportion of resistant hypertensive patients  with primary hyperaldosteronism (PA) – the most common form of secondary hypertension caused by a nodule or hyperplasia of the adrenal glands – we estimate over a million Americans have undiagnosed PA. Furthermore, it has been shown that patients with PA with the same blood pressure as comparable patients with primary hypertension have worse outcomes.

In our study, we found that identifying and appropriately treating patients with PA can improve long-term outcomes in patients in a large number of patients who have resistant hypertension.

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Brain Damage From Chronic Hypertension Studied

Daniela Carnevale, PhD, Researcher Laboratory of Giuseppe Lembo, MD, PhD Dept. of Molecular Medicine "Sapienza" University of Rome & Dept. of Angiocardioneurology and Translational Medicine IRCCS Neuromed - Technology Park Località CamerelleMedicalResearch.com Interview with:
Daniela Carnevale, PhD, Researcher
Laboratory of Giuseppe Lembo, MD, PhD
Dept. of Molecular Medicine
“Sapienza” University of Rome
& Dept. of Angiocardioneurology and Translational Medicine
IRCCS Neuromed – Technology Park
Località Camerelle

Medical Research: What is the background for this study?

Dr. Carnevale: Nowadays, one of the most demanding challenge in medicine is preserving cognitive functions during aging. It is well known that cardiovascular risk factors have a profound impact on the possibility of developing dementia with aging. However, we have no means to investigate this aspect in patients with cardiovascular diseases. Indeed, although we have clear clinical paradigms to explore target organ damage of vascular diseases like hypertension, we are less prepared to afford the brain damage that may result from chronic vascular diseases and impact on cognitive functions. Thus, we aimed at finding a diagnostic paradigm to assess brain damage that could predict for future development of dementia. Since it is becoming increasingly clear that hypertension may determine cognitive decline, even before manifest neurodegeneration, we elaborated a paradigm of analysis that are essentially focused on brain imaging and cognitive assessment. In particular, we used diffusion tensor imaging (DTI) on magnetic resonance that allows to reconstruct white matter connections that correlate with selective cognitive functions, and specifics tests for the evaluation of subtle alterations of cognitive functions.

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ACE Inhibitors Not A Good First Choice For Hypertension in Blacks

MedicalResearch.com Interview with:
Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
The Leon H. Charney Division of Cardiology,
Associate Professor of Medicine,
New York University Langone School of Medicine,
Principal Investigator ISCHEMIA-CKD trial

Medical Research: What is the background for this study? What are the main findings?

Dr. Bangalore: Angiotensin converting enzyme inhibitors (ACEi) are a common class of antihypertensive agents used for the management of hypertension. In many national and international hypertension guidelines, they are recommended as a first line agent. However, their efficacy and safety in hypertensive Blacks is not known.

In an analysis of hypertensive blacks we found that ACEi were consistently inferior to that of calcium channel blockers or thiazide diuretics with a higher risk of cardiovascular events.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bangalore: Although ACEi are recommended as first line agents by national and international guidelines, they likely are not a great choice for hypertensive blacks. In fact few of the guidelines recognize this and recommend calcium channel blockers or diuretics for hypertensive blacks–consistent with the results seen in our study.
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Reminders Can Increase Adherence To Home Blood Pressure Monitoring

Dr. Linnea A. Polgreen, Ph.D. Assistant Professor, Health Services Research Department of Internal Medicine, University of Iowa Coralville, IAMedicalResearch.com Interview with:
Dr. Linnea A. Polgreen, Ph.D.
Assistant Professor, Health Services Research
Department of Pharmacy Practice and Science
Iowa City, IA

Medical Research: What is the background for this study? What are the main findings?

Dr. Polgreen: Many patients with hypertension are unaware that they have hypertension. Furthermore, a substantial number of patients diagnosed with hypertension are poorly controlled. Unfortunately there is no point-of-care test to diagnose hypertension. For most patients with multiple to moderate hypertension, multiple measurements are needed over time to confirm the diagnosis. This need to obtain multiple measurement often delays the diagnosis of hypertension, and delays potential for changes in therapy for those who are diagnosed but poorly controlled. Patients are routinely reminded to check their blood pressure measurements at home. However, these measurements often do not occur or are not collected in a timely fashion. Recently electronic medical records (EMRs) have built portals for patients to enter data such as blood pressure measurements, but it is unclear how effective these portals will be for diagnosing and treating high blood pressure.We studied 121 patients with at least one high blood pressure measurement in the past year and randomized them to three groups.

  • The first group received text messages to which they were told to reply with their blood pressure measurements.
  • The second group was sent text messages reminding them to enter their blood pressures measurements in the hospital’s EMR portal.
  • The third group was instructed to enter their blood pressure measurements in the EMR portal, but they were not given reminders. Automated messages were sent to each patient in the bi-directional text messaging and EMR+reminder groups twice daily for up to 15 days. For the EMR only group, only 47.8% of patients successfully recorded a total of 14 blood pressure measurements within 15 days. For the EMR + reminder group, this percentage was 81.2%, and for the bi-directional text messaging group, it was 97.7%. Continue reading

Short Follow-Up Intervals For Hypertension Reduces Adverse Events

dr-alexander-turchinMedicalResearch.com Interview with:
Dr. Alexander Turchin M.D.,M.S.
Director of Informatics Research
Division of Endocrinology, Brigham and Women’s Hospital
Boston, MA

Medical Research: What is the background for this study? What are the main findings?

Dr. Turchin: Hypertension is the most common risk factor for cardiovascular events. High blood pressure increases the risk for stroke, myocardial infarction, heart failure and kidney failure. Treatment of high blood pressure reduces these risks. However, our understanding of optimal treatment of hypertension is incomplete. In particular, there is little information to guide clinicians on how quickly they should achieve blood pressure control in their patients. There have been no clinical trials focusing on this question. Current guidelines are sparse and are based only on expert opinion.

Our study analyzed treatment of nearly 90,000 patients in primary care practices in the U.K. between 1986 and 2010. We found that patients whose blood pressure medications were adjusted within 1.4 months after systolic blood pressure reached over 150 mm Hg and whose blood pressure was re-assessed within 2.7 months after their treatment was adjusted had the lowest risk for acute cardiovascular events and death from any cause.

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New Hypertension Guidelines Found To Be Cost-Effective

Andrew Moran, MD, MPH Herbert Irving Assistant Professor of Medicine Columbia University Division of General Medicine Presbyterian Hospital 9th floor East room 105 New York, NY 10032MedicalResearch.com Interview with:
Andrew Moran, MD, MPH
Herbert Irving Assistant Professor of Medicine
Columbia University Division of General Medicine
Presbyterian Hospital  New York, NY 10032

Medical Research: What is the background for this study? What are the main findings?

Response: In 2014, a panel appointed by the Eighth Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure (JNC 8) recommended new guidelines for high blood pressure (hypertension ) treatment in U.S. adults.  The guidelines made sweeping changes to the prior guidelines and stirred up controversy among hypertension and public health experts.  Essentially, the panel recommended more conservative treatment targets that narrowed the population eligible for treatment with blood pressure-lowering medications.  Nonetheless, about 28 million U.S. adults have uncontrolled hypertension even under the new more conservative guidelines.  We asked the question:  are the new guidelines cost-effective? That is, does treating this common condition with the available medicines add more health and reduce medical costs?  It is surprising that this question has rarely been answered before.

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Isolated Systolic Hypertension in Young Adults Linked To Increased Risk Of Cardiovascular Death

Donald M Lloyd-Jones, MD/ScM Senior Associate Dean for Clinical and Translational Research Chair, Department of Preventive Medicine Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) Eileen M. Foell Professor Northwestern University Feinberg School of MedicineMedicalResearch.com Interview with:
Donald M Lloyd-Jones, MD/ScM
Senior Associate Dean for Clinical and Translational Research
Chair, Department of Preventive Medicine
Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS)
Eileen M. Foell Professor
Northwestern University Feinberg School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Lloyd-Jones: We undertook this study in order to understand the long-term implications of isolated systolic hypertension (that is, SBP >=140 mm Hg with DBP <90 mm Hg) in younger adults. As you may know, hypertension becomes increasingly common with age. However, it does occur in younger adults, and we are seeing early onset more often recently as a result of the obesity epidemic. In general, we know that diastolic hypertension (DBP >=90 mm Hg) is more common in younger adults, but after age 50 isolated systolic hypertension is by far the most common type of hypertension seen. Prior small studies have suggested that isolated systolic hypertension might be “benign” in younger adults, or just the result of white coat effect with no implications. However, in the current study, we observed that isolated systolic hypertension in younger adults (mean age 34 y) was in fact associated with higher risk (~25% higher risk) for cardiovascular and coronary death over 30 years’ follow up compared with “normal” levels of blood pressure. Interestingly, the relative risk was higher for young women with isolated systolic hypertension, with a doubling of coronary mortality risk. The implications of the study are that clinicians should not ignore isolated systolic hypertension in younger adults, since it clearly has implications for their future health. The USPSTF recently suggested using 24-hour ambulatory blood pressure monitoring to diagnose hypertension. Our results would support the use of this technology in younger adults suspected of having hypertension, to confirm the office-based diagnosis and define the type of hypertension to understand prognosis and inform treatment decisions.

 

Citation:

Yuichiro Yano, Jeremiah Stamler, Daniel B. Garside, Martha L. Daviglus, Stanley S. Franklin, Mercedes R. Carnethon, Kiang Liu, Philip Greenland, Donald M. Lloyd-Jones. Isolated Systolic Hypertension in Young and Middle-Aged Adults and 31-Year Risk for Cardiovascular Mortality. Journal of the American College of Cardiology, 2015; 65 (4): 327 DOI: 10.1016/j.jacc.2014.10.060


MedicalResearch.com Interview with: Donald M Lloyd-Jones, MD/ScM, Senior Associate Dean for Clinical and Translational Research, Chair, Department of Preventive Medicine, & Northwestern University Feinberg School of Medicine (2015). Isolated Systolic Hypertension in Young Adults Linked To Increased Risk Of Cardiovascular Death MedicalResearch.com

Brain Functions May Be Affected By Chronic High Salt Intake

Charles Bourque PhD James McGill Professor Centre for Research in Neuroscience Montreal General Hospital Montreal QC, CanadaMedicalResearch.com Interview with:
Charles Bourque PhD
James McGill Professor
Centre for Research in Neuroscience
Montreal General Hospital Montreal QC, Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Bourque: Previous work has established that there is a link between a high level of dietary salt intake and the development of hypertension. In particular, so-called “salt-sensitive” individuals display increases in blood pressure that correlate with significantly increased levels of serum sodium concentration. Increased sodium levels are known to cause an excitation of vasopressin (VP)-releasing neurons of the hypothalamus. We therefore tested the hypothesis that this increase can contribute to the increase in blood pressure associated with high sodium intake in rats.

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Isolated Systolic Hypertension Declines in Prevalence

MedicalResearch.com Interview with:
Xuefeng (Chris) Liu, PhD
Associate Professor, School of Nursing
Ann Arbor, MI 48109

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Liu: Isolated systolic hypertension (ISH), defined as a systolic blood pressure (SBP) of ≥ 140 mm Hg and a diastolic blood pressure (DBP) of < 90 mm Hg, is an important hypertension subtype. Isolated systolic hypertension is often characterized as a phenomenon of aging and becomes the major form of hypertension for people aged 50 or more. Elevated SBP has been thought to be more important than elevated DBP as a risk factor for adverse cardiovascular and renal outcomes. When combined with other risk factors such as poor diet and lack of exercise, untreated Isolated systolic hypertension can lead to serious health problems (e.g. stroke, heart disease, and chronic kidney disease). The existing studies of pattern changes in rates of Isolated systolic hypertension in the US adult population focus on uncontrolled hypertension subtypes among individuals with uncontrolled blood pressure, and the prevalence and changes of untreated ISH in the general population was not the main focus. In addition, the studies were based on the data collected two decades ago. More recent prevalence estimates and long-term changes of ISH among US untreated adults are needed to fill the gap in the hypertension literature.

In our study, we used data from the National Health and Nutrition Examination Survey 1999-2010, conducted by CDC National Center for Health Statistics. We found that the prevalence of untreated ISH significantly decreased from 1999-2004 to 2005-2010. Old persons, females, and non-Hispanic blacks had higher prevalence of untreated Isolated systolic hypertension. Compared with 1999-2004, the prevalence of untreated Isolated systolic hypertension in 2005-2010 declined among older and female individuals. Further stratification analyses showed that treated ISH improved over time for older non-Hispanic whites and blacks, non-Hispanic white females, older individuals with a college education or above and females with a high school education or below.

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Childhood Atopic Dermatitis Linked To Obesity And Hypertension

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, IllinoisMedicalResearch.com Interview with:
Dr. Jonathan L. Silverberg MD PhD MPH

Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

Medical Research: What is the background for this study?

Dr. Silverberg: Previous studies found associations between obesity and atopic dermatitis (AD). However, little was known about the association between AD and metabolic risk factors, such as central obesity and high blood pressure.
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Older Adults Mainly Excluded From Hypertension Trials

Leah Goeres Department of Pharmacy Practice, College of Pharmacy, Oregon State University, Corvallis, OregonMedicalResearch.com Interview with:
Leah Goeres

Department of Pharmacy Practice, College of Pharmacy,
Oregon State University, Corvallis, Oregon

Medical Research: What is the background for this study? What are the main findings?

Response: Hypertension is a very common condition and as adults age they are more likely to have hypertension. Knowing how best to treat hypertension in older adults is important for healthcare practitioners; however, dilemmas arise when treating older adults. Which medication to choose, which dose, and which blood pressure to target are all factors to consider. Additionally, old age is accompanied by many physiologic changes to the body and these changes may affect the safety and effectiveness of medicines that treat hypertension. The evidence base (number of studies) for safe and effective treatments shrinks substantially in older populations and guidelines offer conflicting recommendations for older adults.

This systematic review had the goal to collect and compare recent hypertension guidelines and major hypertension studies with respect to age. Information that will help clinicians evaluate  the benefits and harms of using antihypertensive medications in people 65 years and older.

The main findings are that older adults ([65 years) have been excluded from clinical trials in the past and this continues to impact the ability to develop evidence-based clinical practice guidelines for management of hypertension in older adults. Adverse effects of antihypertensive medications are not consistently reported in trials with older adults, so accurately weighing risks and benefits in this population is challenging. While benefits are clear for a systolic blood pressure less than 150 mmHg, stricter control in adults over 65 years is not shown to be consistently better.

Medical Research: What should clinicians and patients take away from your report?

Response: The goal of a systolic pressure at or below 140 mmHg has been around a long time, and there’s still skepticism among some practitioners about accepting a higher blood pressure in older adults. When we looked at the body of evidence, it was not convincing that 140 mmHg should be the goal for older adults. Practitioners need to understand that keeping systolic blood pressure in older adults below 150 mmHg is important, it’s what we consider a mild level of control. For older adults that level is also good enough. After an extensive review, there was no significant evidence that more intensive management is necessary. The risks of these medications should be weighed against the benefits, it is difficult to do this when risks are not reported as meticulously as the benefits are reported.  In a lot of ways, practitioners are left to make educated guesses at the best course of treatment for the patient. It’s important to respect the unknown, in terms of decision making and make sure the older patient understands what we do know about treating high blood pressure and what we don’t know, as part of shared decision making.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: We definitely need more research in older population. For example, there are only a few studies that pertain to adults over the age of 80 years. We also need more standardization in treatment regimens that are used in clinical trials. There is too much heterogeneity in medications that are used in clinical trials and this poses problems for combining and comparing the results of different studies. We need adverse events to be carefully recorded and reported in hypertension trials.

Citation:

Pharmacotherapy for Hypertension in Older Adults: A Systematic Review
Goeres LM1, Williams CD, Eckstrom E, Lee DS. 
Drugs Aging. 2014 Oct 17. [Epub ahead of print]

 

 

 

 

Health Insurance, Regular Healthcare Visits Linked To Hypertension Control

Dr. Brent M. Egan MD Adjunct Professor Medical University of South CarolinaMedicalResearch.com Interview with:
Dr. Brent M. Egan MD
Professor of Medicine
University of South Carolina School of Medicine Greenville
Senior medical director of the Care Coordination Institute
Greenville, South Carolina

Medical Research: What are the main findings of the study?

Dr. Egan: The study was undertaken to determine progress toward the Healthy People 2020 goals of controlling hypertension or high blood pressure in 61.2% of all adults with the condition. What we found is that hypertension control has changed very little from 2007 through 2012. In 2011-2012, an estimated 51.2% of all hypertensive adults were controlled, which is 10% below the 2020 goal.  The analysis indicated that healthcare insurance and at least two healthcare visits yearly were related to both the likelihood that hypertension would be treated and controlled.
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Do Garlic Preparations Lower Blood Pressure?

MedicalResearch.com Interview with:
Prof. Dr. med. Alain Nordmann
Innere Medizin FMH
Basel, Switzerland

Medical Research: What are the main findings of the study?

Dr. Nordmann: Based on available randomised controlled trials, garlic preparations seem to lower blood pressure in individuals with hypertension in the short term. However, the quality of the studies and the lack of long-term data preclude the routine use of garlic preparations to lower blood pressure in individuals qualifying for antihypertensive drug therapy.
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Higher Protein Intake Linked To Lower Blood Pressure

Lynn L. Moore, DSc, MPH Co-Director, Nutrition and Metabolism Assoc Prof of Medicine Preventive Medicine & Epidemiology Department of Medicine Boston University School of Medicine Boston, MA 02118MedicalResearch.com Interview with:
Lynn L. Moore, DSc, MPH
Co-Director, Nutrition and Metabolism
Assoc Prof of Medicine
Preventive Medicine & Epidemiology Department of Medicine
Boston University School of Medicine
Boston, MA 02118

Medical Research: What are the main findings of the study?

Response: Our data were derived from 1,361 adults (aged 30-54 years) enrolled in the Framingham Offspring Study and showed that men and women who consumed higher amounts of protein had lower blood pressures (both systolic and diastolic blood pressures) after four years of follow-up. We then followed them for an average of about 11 years and found that those who consumed the most protein (approximately 103 g/day) had about a 40% lower risk of developing high blood pressure than those consuming about half that amount. These beneficial effects were even more pronounced when higher protein intakes were combined with high fiber intakes.
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Better Fitness May Delay Increased Blood Pressure Due To Aging

Xuemei Sui, MD, MPH, PhD Assistant Professor, Department of Exercise Science Division of Health Aspects of Physical Activity Arnold School of Public Health University of South Carolina Columbia, SC 29208Xuemei Sui, MD, MPH, PhD
Assistant Professor, Department of Exercise Science
Division of Health Aspects of Physical Activity
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208

Medical Research: What are the main findings of the study?

Dr. Sui:
First, blood pressure is inversely associated with cardiorespiratory fitness levels among men. People in higher fitness categories had lower blood pressure than those in lower fitness categories.

Second, fitness is a strong effect modifier for the systolic blood pressure aging trajectory.
A higher fitness level can significantly delay the natural age-associated increase in blood pressure.
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ER Visits For Hypertension Complications Rise

MedicalResearch.com Interview with:
Sourabh Aggarwal, MD
University College of Medical Sciences
Western Michigan University School of Medicine in Kalamazoo.

Medical Research: What are the main findings of the study?

Dr. Aggarwal: The main findings were that from 2006 to 2011:

  • ER visits for essential hypertension increased by 25 percent, while the admission percentage for these patients fell by 15 percent.
  • ER visits for hypertension with complication and secondary hypertension increased by 19 percent, while the admission percentage for these patients fell by 12 percent

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Silent Heart Attack Common In Asymptomatic Resistant Hypertension

Dr. Rodrigo Modolo Department of Pharmacology Faculty of Medical Sciences University of Campinas–UNICAMP Campinas, SP, Brazil;MedicalResearch.com Interview with:
Dr. Rodrigo Modolo
Department of Pharmacology
Faculty of Medical Sciences University of Campinas–UNICAMP
Campinas, SP, Brazil;


Medical Research: What are the main findings of the study?

Dr. Modolo: The main findings of this study are the encounter of a high prevalence of silent myocardial ischemia (assessed by myocardial perfusion scintigraphy) in resistant hypertension and the identification of predictors of this alteration in this population.

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Is There A Sweet Spot For Systolic Blood Pressure Control?

Dr. John J. Sim Division of Nephrology and Hypertension Kaiser Permanente Los Angeles Medical Center, Los Angeles,MedicalResearch.com Interview with:
Dr. John J. Sim
Division of Nephrology and Hypertension
Kaiser Permanente Los Angeles Medical Center, Los Angeles,


Medical Research: What are the main findings of the study?

Dr. Sim: Among a large diverse population of treated hypertensive people, those who achieved systolic blood pressures (SBP) in the ranges of 130-139mm Hg had the lowest risk for death and end stage renal disease (kidney failure).  Not surprisingly, those with SBP above 139 had incrementally greater risk, but somewhat surprising was that those with SBP under 130 also had a greater risk for death and kidney failure.
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What is the Sweet Spot For Hypertension Control?

Carlos J. Rodriguez, MD, MPH Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North CarolinaMedicalResearch.com Interview with
Carlos J. Rodriguez, MD, MPH
Department of Medicine and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina

MedicalResearch: What are the main findings of the study?

Dr. Rodriguez: As a clinician there is a notion suggesting that lower blood pressure is better but our current research to date is controversial and not conclusive. We wanted to study a large group of people with hypertension and see whether over 20 years of follow up, if a lower systolic blood pressure would be associated with lower cardiovascular events (heart attack, stroke, heart failure, angina). We hypothesized that there would be a linear association between blood pressure and events, that lower blood pressure would be associated with lower events and that as the blood pressure went up there would be more events. We found this was not the case but that hypertensives with a blood pressure between 120-138mmhg have the greatest benefit and those with a blood pressure less than 120mmhg did not have additional benefit.
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Obstructive Sleep Apnea: Obesity, Sleep Apnea and Hypertension Linked

Julio A. Chirinos, MD, PhD Assistant Professor of Medicine Director, CTRC Cardiovascular Phenotyping Unit Perelman School of Medicine, University of Pennsylvania Director of Non-Invasive Imaging Philadelphia VA Medical CenterMedicalResearch.com Interview with:
Julio A. Chirinos, MD, PhD
Assistant Professor of Medicine
Director, CTRC Cardiovascular Phenotyping Unit
Perelman School of Medicine, University of Pennsylvania
Director of Non-Invasive Imaging
Philadelphia VA Medical Center

MedicalResearch: What are the main findings of the study?

Dr. Chirinos: The main findings of the study is that, among patients with obesity and moderate to severe obstructive sleep apnea, obesity, rather than OSA, appears to be the primary cause of inflammation, insulin resistance and dyslipidemia. However, both obesity and obstructive sleep apnea appear to be causally related to hypertension. In this population, weight loss, but not CPAP, can be expected to reduce the burden of inflammation, insulin resistance and dyslipidemia. However, CPAP, among patients who comply with therapy, can be expected to provide a significant incremental benefit on blood pressure. The latter is an important potential benefit of CPAP and should not be disregarded.
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Benefits of Managing Mild Hypertension in Younger Patients

​MedicalResearch.com Interview with:
Eleni Rapsomaniki, PhD
The Farr Institute of Health Informatics Research
Department of Epidemiology & Public Health
University College London London

MedicalResearch: What are the main findings of the study?

Dr. Rapsomaniki: Our data shows that hypertension is associated with considerable reduction in CVD-free life expectancy. Based on our estimates a 30-year old with hypertension suffered from CVD 5 years earlier compared to a similarly aged individual with normal blood pressure.

We noted substantial heterogeneity in the associations of blood pressure with specific cardiovascular outcomes. For example a 20 mmHg increase in systolic blood pressure was associated with ~40% higher risk of stable angina, and intracerebral or subarachnoid haemorrhage but less than 10% increase in risk of abdominal aortic aneurysm.

In all age groups from 30 to over 80 people with a systolic blood pressure 90–114 mm Hg and a diastolic blood pressure of 60–74 mm Hg had the lowest risk of all cardiovascular diseases, and we found no J-shape associations.
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Online Educational Game Improved Clinicians’ Hypertension Knowledge and Patient Outcomes

Dr. Price Kerfoot MD, EdM Rabkin Fellow in Medical Education Associate Professor of Surgery, Harvard Medical SchoolMedicalResearch.com Interview with:
Dr. Price Kerfoot MD, EdM
Rabkin Fellow in Medical Education
Associate Professor of Surgery, Harvard Medical School

 

MedicalResearch: What are the main findings of the study?

Dr. Kerfoot:
(1) An online spaced education game improved clinicians’ knowledge of hypertension intensification and generated a modest but significant improvement in time to blood pressure target among their patients with hypertension.
(2) As a method to increase clinicians’ long-term knowledge, the spaced education game was significantly more effective than providing the identical content via a traditional method (online posting with e-mail reminders).

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Chronic Hypertension Increases Risk of Pregnancy Complications

MedicalResearch.com Interview with:
Dr Kate Bramham
Division of Women’s Health
King’s College London
Women’s Health Academic Centre KHP
London, SE1 7ER

MedicalResearch.com: What are the main findings of the study?

Dr. Bramham: This meta-analysis of nearly 800,000 pregnancies from 55 studies has shown that women with chronic hypertension have a significantly increased incidence of pregnancy complications including superimposed pre-eclampsia, preterm delivery, low birth weight infants, perinatal loss and neonatal unit admission.

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Too Little and Too Much Salt Associated with Increased Mortality

MedicalResearch.com Interview with:
Niels Graudal, MD, DrMSc
Senior Consultant
Department of Internal medicine/Infectious Medicine/Rheumatology IR4242
Copenhagen University Hospital, Rigshospitalet
Denmark

Dr. Graudal: There are no studies, which show what happens with the risk of cardiovascular death or mortality if you change your sodium intake. Our study shows the association of sodium intake as it is with cardiovascular disease and mortality, which is only the second best way to consider the problem, but as the best way does not exist we have accepted this approach. There have been two different assumptions concerning the risks of sodium intake. One is that there is an increasing risk of heart disease, stroke and death of salt intake above 2300 mg, and one is that salt is not dangerous at all. Our study shows that both positions partially may be true, as a salt intake above 4900 mg is associated with increased risk of cardiovascular disease and mortality, whereas the present normal salt intake of most of the world’s populations between 2300 mg and 4900 mg is not associated with any increased risks. In addition our study shows that a low sodium intake below 2300 mg is also associated with increased risk of cardiovascular disease and death.

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New Hypertension Guidelines Potentially Affect Millions of Americans

MedicalResearch.com Interview with:
Ann Marie Navar-Boggan, MD, PhD
Division of Cardiology,
Duke University Medical Center
Durham, North Carolina

MedicalResearch.com: What are the main findings of the study?

Dr. Navar-Boggan: Two groups of adults are really affected by the updated guidelines. First, 13.5 million adults, including one in five adults over the age of 60, were previously considered to have uncontrolled blood pressure but now meet new guideline goals.

Next, 14 million adults over the age of 60 (one in four adults in this age group) are currently on blood pressure lowering therapy and meeting the older, more stringent targets. The guidelines state that no changes are necessary in this group, but they may be eligible for reduced therapy, particularly if they have had side effects or difficulty with the therapies they are taking.
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Long-Term Risk of Stroke Raised by PreHypertension

MedicalResearch.com Interview with:
Dingli Xu, MD
From Department of Cardiology
Nanfang Hospital, Southern Medical University, Guangzhou, China

MedicalResearch.com:  What are the main findings of the study?

Answer:Our study showed that after controlling for multiple cardiovascular risk factors, the blood pressure range at 120-139/80-89 mm Hg (defined as ‘prehypertension’ in JNC 7), is significant associated with long-term risk of stroke. The results were consistent across stroke type, stroke endpoint, age, study characteristics, follow-up duration, and ethnicity. More importantly, even low-range prehypertension (BP 120-129/80-84mmHg) increased the risk of stroke compared with optimal BP (<120/80 mm Hg), and the risk was higher in individuals with high-range prehypertension (BP 130-139/85-85mmHg). In particular, we found that compared with individuals with optimal blood pressure individuals with low-range prehypertension were 44% more likely to develop stroke, and this risk was even greater (95%) in individuals with high-range prehypertension.

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